The letter

On Wednesday night, we went to visit our newborn baby nephew, Carter. He was still in his newborn sleep coma, with eyes glued shut and making occasionally whimpery newborn noises. The nurse came in and unwrapped him from his cocoon-like swaddle, and he started making little sucking motions with his mouth, but he stopped as soon as she wrapped him up again.

I'd forgotten all about this newborn coma stage, which God must have ingrained in babies to give parents an appropriate amount of time to stare in awe at the tiny creation that has just emerged...before the screaming-of-unknown-cause sets in. As far as I can tell, that stage lasts 2-24 months. The jury's still out on that.

I had the amazing privilege of being able to be in the delivery room when Olivia was born. Her birthmother had a c-section, so I was sitting behind the curtain near her head and didn't actually SEE her emerge (um, surgery, blood, no thank you), but it was still an awesome experience. She was so new and wiggly with scrunchy-up hands and eyes squeezed shut...angry and thrashing around at whoever was responsible for making her leave her warm haven and end up in this cold, bright room.

I have often regretted that my husband couldn't experience this as well. And while adoption has been a blessing, I still harbor a deep desire to give him a child whose growth we can chart and observe from the beginning, and whose birth we can witness together.

I don't think I realized how much I still wanted this.

Yesterday, I received a letter I'd been anticipating since August. After discussion with some FertilityCare Educators, I was encouraged to submit my medical history and charts to Dr. Thomas Hilgers for review. I thought, at the very least, I was interested in finally getting some answers about what is wrong with my screwed-up fertility.

I don't know what I was expecting. I KNEW he couldn't diagnose me based on all that information. I know his reputation for finding and fixing such problems, and it is stellar. But I also know that, in most cases, it requires a trip to the Pope Paul VI Institute and extensive testing before you get to the bottom of the problem.

In retrospect, I suppose my medical history is spotty, at best. We did a lot of tests in our fertility fixing phase a few years ago, but not in the methodical, thorough manner that Dr. Hilgers requires. Most of those tests will have to be repeated under Dr. Hilger's, whose technique is more specific and directed at the causes of fertility.

I don't fault my amazing doctor at the hit-and-miss approach. In most cases, such an approach would have found the right cause and removed the problem. I have seen dozens of couples achieve and carry a successful pregnancy after just a hormone supplement, or a laparoscopy, or a round of Clomid. Or even a hysterosalpingogram (HSG)...a fancy name for shooting dye through the uterus and tubes and taking x-rays to see if there is any blockage. The radiologist who performed my HSG made small talk, asking about infertility since many women have this test for that reason. I remember, very clearly, that he said something like, "Well, I've seen a lot of women get pregnant after this test...the pressure sometimes removes a blockage from the tubes...with any luck, that'll happen for you." Yes, thank you, Dr. Insensitive, for the false hopes.

Dr. Hilger's evaluation phase is overkill for some couples because he likes to do testing for everything that could possibly be wrong, based on the charting and clues we already have. It's very, very effective, but more than some people NEED to fix the problem.

It turns out that I am probably one who needs the super thorough approach to get a diagnosis.

I read Dr. Hilgers' letter several times, even though nothing in it was a surprise. There are signs pointing to a half-dozen different possible causes of infertility. To pinpoint the exact cause, I need to repeat much of what has been done in the past and add another several tests, including hormone panels and an ultrasound series covering several days. Translation: Spend 7-10 days in Omaha to endure a lot of poking, prodding and evaluation, and we'll have a shot at a successful treatment plan.

My first reaction to the letter was to try to figure out how quickly I could come up with two weeks of free time to devote to this. Seriously. I didn't even think about the money that we will undoubtedly have to budget for such an out-of-network endeavor. All I could think about was fix the problem.

And then I took a breath. There are several factors to consider. There is no hurry. We can accomplish this in the summer, when I'm not babysitting. It will give us time to research the costs and save some money. Do I even really want this? It could fix my weird cycles, but there are no guarantees of pregnancy.

And there it is. All this time I thought that what was bothering me was this mystery of why my body does weird things and wanting to fix that. But what I really want, down deep in the core of my being, is to be able to conceive. And I think that really scares me.

This has nothing to do with being unhappy with adoption. I am thankful for my screwed up fertility to the extent that it has led us to Olivia. I have a great desire to adopt again. It is such an amazing experience, and I don't feel like any less of a Mom because my daughter did not spring forth from me. She is ours and we are hers and God knew exactly what we all needed when he led her birthmother to us.

But I teach FertilityCare. It has been a part of who I am for a quarter of my life. Appreciation for fertility and the possibility that it can lead to a whole new person...it's ingrained in me. I want to pursue this evaluation not just because I want to fix a broken system, but because I want to be a part of what I have taught for so many years. I want to be on the inside of this fertility club...not just a spectator, talking about the blessings of fertility and the challenges of periodic abstinence when I really don't have any context for either of these things.

I don't know where this will go yet. I will research the costs, talk to the nurses, discuss with my husband, pray. We don't need to decide anything right away, and that is a blessing. But it will be in the back of my mind for quite a while.